HEART RATE AT OFFICE VISIT AND LONG-TERM CARDIOVASCULAR EVENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Abstract

Objective: Elevated heart rate at admission or discharge is known to be associated with poor cardiovascular outcomes in patients with acute myocardial infarction (AMI). The association between averaged heart rate at office and cardiovascular outcomes in patients with AMI has been studied scarcely. We investigated the relationship of heart rate at office with long-term cardiovascular outcomes in AMI. Design and method: We analyzed a total of 7,840 patients with heart rate measured at least 3 times after hospital discharge between January 2004 and April 2015 from COREA-AMI registry. The values of heart rate measured at office visit were averaged and categorized into four groups by quartiles (<68, 68-74, 74-80, and >80 beats per minute). The primary end point was a composite of cardiovascular death, myocardial infarction, and ischemic stroke. Results: During a median of 5.7-year follow up, major adverse cardiovascular events (MACE) affected 1,357(17.3%) patients. The averaged heart rate of higher than 80 beat per minute (b.p.m) was associated with an increased incidence of primary outcomes compared to the averaged heart rate of 68-74 b.p.m as reference. (Adjusted hazard ratio 1.37, 95% CI 1.19-1.58, p<0.0001) Increased heart rate of 1 b.p.m was an independent predictor of MACE (Adjusted hazard ratio 1.025, 95% CI 1.02-1.03, p<0.001). When dichotomized into < 74 or > 74 b.p.m, lower averaged heart rate was not associated with incidence of primary outcomes in patients with LV systolic dysfunction in contrast to those without LV systolic dysfunction. Conclusions: Elevated averaged heart rate at office visit after AMI was associated with increased risk of cardiovascular outcomes.